Individual
JEANETTE COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
400 ROUTE 10 WEST, RANDOLPH, NJ 07869
(973) 945-8790
Mailing address
606 DOROTHY LN, LANDING, NJ 07850-1411
(973) 945-8790
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT00073300
NJ
Other
Enumeration date
03/27/2014
Last updated
06/30/2015
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